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fazeel
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From: art fougner, mdDate: 12/29/04 18:19:12
To: Multiple recipients of list ULTRASOUND
Subject: Nuchal Cord Redux
>From the White Journal Early View ( pre-release)...
Ultrasound detection of nuchal cord prior to labor induction and the
risk of Cesarean section
E. Peregrine, P. O'Brien, E. Jauniaux
Department of Obstetrics and Gynaecology, University College London
Hospitals, London, UK
Abstract
Objectives
To investigate the ability of ultrasound to detect the presence of a
nuchal cord immediately prior to induction of labor and the association
of its presence with delivery by Cesarean section.
Methods
A transabdominal ultrasound scan using gray-scale and color Doppler
imaging was performed immediately prior to induction of labor in 289
women in a prospective study to assess the presence of a nuchal cord.
The presence of a nuchal cord was classified as present, absent or
uncertain. The outcomes of labor, delivery and the neonates were
obtained from the patient notes after delivery.
Results
A nuchal cord was present at 18% of deliveries. The incidence was not
affected by parity, fetal position or reduced amniotic fluid volume. The
sensitivity of ultrasound in diagnosing a nuchal cord was 37.5%, with
specificity, positive and negative predictive values of 80%, 29% and
85%, respectively. The presence of a nuchal cord did not significantly
increase the risk of delivery by Cesarean section (35% vs. 28%;
relative risk = 1.22; 95% CI, 0.80-1.87), instrumental delivery for
fetal distress, an abnormal cardiotocograph in labor or at delivery, an
Apgar score < 7 at 1 min, arterial cord pH < 7.1 or neonatal unit
admission.
Conclusions
The sensitivity of the ultrasound diagnosis of a nuchal cord is low
prior to induction of labor at term. A nuchal cord does not appear to
increase the risk of Cesarean section or of poor neonatal outcome. The
low ultrasound detection rate of a nuchal cord limits its use in
decision making prior to induction of labor in high-risk pregnancies.
Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
art
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art fougner, md
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